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Workforce Issues During COVID-19
ACP Chapter Action Tool Kit
Prepared by ACP’s Division of Governmental Affairs and Public Policy
April 17, 2020
Federal Workforce Programs:
On March 27, the President signed into law H.R. 748, the “Coronavirus Aid, Relief and Economic Security Act” (CARES Act), which includes several provisions designed to support the primary care physician workforce during this national emergency and beyond. The CARES Act extends mandatory (e.g. not subject to the annual congressional appropriations process) funding for community health centers, the National Health Service Corps, and the Teaching Health Center Graduate Medical Education Program at current levels through November 30, 2020. The CARES Act also provides $1.32 billion in supplemental funding to community health centers on the front lines of testing and treating patients for COVID-19. Funding for these programs was set to expire on May 22, 2020. The CARES Act also reauthorizes the health professions training programs Title VII of the Public Health Service Act (PHSA), including the training of practitioners in family medicine, general internal medicine, geriatrics, and pediatrics through the Section 747 Primary Care Training and Enhancement (PCTE) program. The new law does lower the PCTE authorization from $125 million previously to $48.924 million, its current FY2020 enacted funding level.
Relief for Medical Residents/Students:
The CARES Act also included the following provisions to help medical students and residents as they are being impacted and even called upon to assist during this COVID emergency:
- Defers student loan payments and interest. Defers student loan payments, principals, and interests through September 30, 2020. Additionally, during this time, involuntary collection related to student loans will be suspended.
- Federal Student Loan Flexibility. Allows students who withdraw from school as a result of COVID-19 to not return Pell grants, other grant assistance, or loans. Additionally, for students who withdraw from school as a result of COVID -19, the current academic term would be excluded from counting toward lifetime subsidized loan or Pell grant eligibility.
- Use of Supplemental Educational Opportunity Grants for Emergency Aid. Schools are allowed to use Supplemental Educational Opportunity Grants as emergency financial aid grants to assist graduate students with unexpected expenses and unmet financial needs that arise as the result of COVID-19.
- Federal Work-Study Flexibility During a Qualifying Emergency. Institutions are allowed to transfer unused work-study funds to be used for supplemental grants. Additionally, it would give institutions the ability to issue work-study payments to student who are unable to work due to work-place closures, as a result of COVID-19, as a lump sum or in payments similar to paychecks.
- Continuing Education at Affected Foreign Institutions. Supports foreign education institutions, including graduate medical programs, as they offer distance learning to U.S. students receiving Title IV funds for the duration of the COVID-19 pandemic.
In a letter to congressional leadership on what should be included in the next COVID-19 response bill as Congress is working on putting together the legislation, ACP advocated for a number of measures for students and residents including loan repayment and tuition relief of at least $20,000. Many residents and medical students are playing a critical role in responding to the COVID-19 crisis and providing care to patients on the frontlines. For residents, COVID-19 is inflicting additional strain as they are redeployed from their primary training programs and put their health on the line caring for the sickest patients, many without appropriate personal protective equipment. Some medical schools, such as New York University, are graduating their students early to deploy them to care for patients during this public health crisis. Residents and early graduated medical students have an average debt of over $200,000, yet will not necessarily be supported by other programs that provide direct financial support to hospitals and other physicians.
State Workforce Programs:
Some states have medical loan forgiveness program for residents and physicians willing to work in underserved areas. During the COVID 19 health emergency, states with loan forgiveness programs should expand their programs for practicing in underserved areas to include frontline residents and physicians providing care to COVID-19 patients. States that do not have a loan repayment program should establish loan forgiveness/repayment program for frontline residents and physicians who are providing care to COVID-19 patients.
International Medicare Graduates (IMGs):
ACP recently sent a letter to Secretary Mike Pompeo, U.S. Department of State (DoS) andKenneth Cuccinelli, Acting Director, U.S. Citizenship and Immigration Services (USCIS) urging them to expedite entrance of international medical graduates who are citizens of other nations (non-US IMGs) into the country and to ensure that lawfully present non-U.S. IMGs are not negatively impacted by the COVID-19 pandemic. ACP is concern that the DoS decision to temporarily suspend visa services and the USCIS announcement that it will not accept new requests for premium processing will have serious healthcare repercussions as the U.S. tries to address this growing national health emergency.
Since sending the letter, fortunately the State Department has agreed to open visa processing for health professionals. According to the State Department announcement, for those foreign medical professionals already in the United States:
- J-1 Alien Physicians (medical residents) may consult with their program sponsor, ECFMG, to extend their programs in the United States. Generally, a J-1 program for a foreign medical resident can be extended one year at a time for up to seven years.
- Note that the expiration date on a U.S. visa does not determine how long one can be in the United States. The way to confirm one’s required departure date is here:https://i94.cbp.dhs.gov/I94/#/home.
- Those who need to extend their stay or adjust their visa status must apply with USCIS. Their website is here: https://www.uscis.gov/visit-united-states/extend-your-stay
To address the shortage of healthcare practitioners during the COVID-19 public emergency, many states are temporary waiving or modifying their licensure requirement to make it easier for physicians in other states to volunteer and practice in their states including retired and inactive physicians.
The Federation of State Medical Boards (FSMB) is tracking laws related to licensure and providing details on licensing inactive or retired physicians who wish to become active during the pandemic.
ACP chapters should urge state officials to:
- Temporarily allow physicians licensed in good standing to practice across state lines. (Note: If considering broad language to include reciprocity for all health care professionals, include language clarifying that health care professionals are subject to the scope of practice laws of the host state and may not exceed the scope of practice established by their home state). See CMS guidance on state licensure of physicians providing care to Medicare patients (PDF).
- Temporarily allow states to mobilize inactive physicians into the workforce, including physicians who temporarily left for family reasons, retired physicians, and non-clinical physicians. The physician’s current or previous license must be in good standing.
- If your state has a loan repayment program, expand state loan forgiveness/repayment programs for practicing in underserved areas to include frontline residents and physicians providing care to COVID-19 patients.
- If your state does not have a loan repayment program, establish loan forgiveness/repayment program for frontline residents and physicians providing care to COVID-19 patients.
- ACP Immigration Position Statement: https://www.acponline.org/acp_policy/policies/immigration_position_statement_2017.pdf
- FSMB’s State Modifying Licensure Requirements/Renewals for Physicians in Response to COVID-19 https://www.fsmb.org/siteassets/advocacy/pdf/state-emergency-declarations-licensures-requirementscovid-19.pdf
- FSMB’s States Expediting Licensure for Inactive/Retired Licensees in Response to COVID-19 https://www.fsmb.org/siteassets/advocacy/pdf/states-expediting-licensure-for-inactive-retired-licensees-in-response-to-covid19.pdf
- NCSL – COVID-19: Occupational Licensing During Public Emergencies: https://www.ncsl.org/research/labor-and-employment/covid-19-occupational-licensing-in-public-emergencies.aspx
- List of States with Medical Loan Forgiveness Programs: https://financialresidency.com/list-of-each-state-with-medical-loan-forgiveness-programs/